Skip to main content
SpringerLink
Log in

Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice

  • Original Article
  • Aesthetic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Object

To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias.

Methods

A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4 years and the average was 5.8 years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap.

Results

The 46 patients were examined during follow-up visits for 6 months to 3 years. An anastomotic fistula was observed in one case (2.2 %). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients.

Conclusion

A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Al-Ghorairy BA, Elashry OM, Al-Housain AE, Mattar AA (2009) Analysis of five-year experience with tubularized incised plate urethroplasty for anterior and mid penile hypospadias. Eur J Pediatr Surg 19:90–95

    Article  CAS  PubMed  Google Scholar 

  2. Bertozzi M, Yildiz A, Kamal B, Mustafa M, Prestipino M, Yigiter M et al (2011) Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias. Pediatr Surg Int 27:1331–1336

    Article  CAS  PubMed  Google Scholar 

  3. Snodgrass W, Yucel S (2007) Tubularized incised plate for mid shaft and proximal hypospadias repair. J Urol 177:698–702

    Article  PubMed  Google Scholar 

  4. Yildiz A, Bakan V (2010) Comparison of perimeatal-based flap and tubularized incised plate urethroplasty combined with single- or double-layer dartos flap in distal hypospadias. Urol Int 84:265–268

    Article  PubMed  Google Scholar 

  5. Babu R, Hariharasudhan S (2013) Tunica vaginalis flap is superior to inner preputial dartos flap as a waterproofing layer for primary TIP repair in midshaft hypospadias. J Pediatr Urol 9:804–807

    Article  PubMed  Google Scholar 

  6. Bakan V (2009) Dartos flap in Snodgrass hypospadias repair. Urol Int 82:372

    Article  PubMed  Google Scholar 

  7. Chandrasekharam VV, Jayaram H (2012) Soft tissue covers in hypospadias surgery: is tunica vaginalis better than dartos flap? J Indian Assoc Pediatr Surg 17:141

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Erol A, Kayikci A, Memik O, Cam K, Akman Y (2009) Single vs. double dartos interposition flaps in preventing urethrocutaneous fistula after tubularized incised plate urethroplasty in primary distal hypospadias: a prospective randomized study. Urol Int 83:354–358

    Article  PubMed  Google Scholar 

  9. Ozturk H (2010) Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas. It is a safe approach. Acta Cir Bras 25:190–193

    PubMed  Google Scholar 

  10. Routh JC, Wolpert JJ, Reinberg Y (2006) Tunneled tunica vaginalis flap is an effective technique for recurrent urethrocutaneous fistulas following tubularized incised plate urethroplasty. J Urol 176(1578–80):1581

    Google Scholar 

  11. Seo S, Ochi T, Yazaki Y, Okawada M, Doi T, Miyano G et al (2015) Soft tissue interposition is effective for protecting the neourethra during hypospadias surgery and preventing postoperative urethrocutaneous fistula: a single surgeon’s experience of 243 cases. Pediatr Surg Int 31:297–303

    Article  PubMed  Google Scholar 

  12. Gapany C, Grasset N, Tercier S, Ramseyer P, Frey P, Meyrat BJ (2007) A lower fistula rate in hypospadias surgery. J Pediatr Urol 3:395–397

    Article  PubMed  Google Scholar 

  13. Chen SC, Yang SS, Hsieh CH, Chen YT (2000) Tubularized incised plate urethroplasty for proximal hypospadias. BJU Int 86:1050–1053

    Article  CAS  PubMed  Google Scholar 

  14. Snodgrass WT (2005) Snodgrass technique for hypospadias repair. BJU Int 95:683–693

    Article  PubMed  Google Scholar 

  15. Ross JH, Kay R (1997) Use of a de-epithelialized local skin flap in hypospadias repairs accomplished by tubularization of the incised urethral plate. Urology 50:110–112

    Article  CAS  PubMed  Google Scholar 

  16. Tavakkoli TK, Mohammadi S (2010) Tunica vaginalis flap as a second layer for tubularized incised plate urethroplasty. Urol J 7:254–257

    Google Scholar 

  17. Patel RP, Shukla AR, Austin JC, Canning DA (2005) Modified tubularized transverse preputial island flap repair for severe proximal hypospadias. BJU Int 95:901–904

    Article  PubMed  Google Scholar 

  18. Zheng DC, Wang H, Lu MJ, Chen Q, Chen YB, Ren XM et al (2013) A comparative study of the use of a transverse preputial island flap (the Duckett technique) to treat primary and secondary hypospadias in older Chinese patients with severe chordee. World J Urol 31:965–969

    Article  PubMed  Google Scholar 

  19. Duckett JJ (1980) Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin N Am 7:423–430

    Google Scholar 

  20. Aoki K, Fujimoto K, Yoshida K, Hirao Y, Ueoka K (2008) One-stage repair of severe hypospadias using modified tubularized transverse preputial island flap with V-incision suture. J Pediatr Urol 4:438–441

    Article  PubMed  Google Scholar 

  21. Vandersteen DR, Husmann DA (1998) Late onset recurrent penile chordee after successful correction at hypospadias repair. J Urol 160(1131–3):1137

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong Province, China

    Weiqiang Liang, Chenyang Ji, Yuhong Chen, Jiaqi Zhang, Yuanyuan Yao & Jinming Zhang

  2. Department of Plastic Surgery, Huizhou Central Hospital, Huizhou, 516000, Guangdong Province, China

    Ganling Zhang

Authors
  1. Weiqiang Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chenyang Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuhong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ganling Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jiaqi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuanyuan Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jinming Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jinming Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liang, W., Ji, C., Chen, Y. et al. Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice. Aesth Plast Surg 40, 535–539 (2016). https://doi.org/10.1007/s00266-016-0659-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-016-0659-0

Keywords

Search

Navigation